LeadingAge NY Calls for Investment of DSRIP 2.0 Funds in Long-Term Care Workforce and Innovative Models

LeadingAge NY called for the allocation of 40 percent of Delivery System Reform Incentive Payment (DSRIP) funds to the long-term/post-acute care (LTPAC) sector in comments submitted to the Department of Health (DOH) on its draft application for an extension and renewal of the DSRIP program. DSRIP is the vehicle through which $6.2 billion in Medicaid savings accrued under the State's Medicaid redesign has been reinvested in the health care delivery system. The current DSRIP program is scheduled to expire on March 31, 2020. The State has prepared a draft application to extend and renew the DSRIP program, seeking an additional $8 billion over four years. While the first phase of DSRIP largely overlooked LTPAC, the draft application for the second phase responds to LeadingAge NY's advocacy and recognizes long-term care reform, including the long-term care workforce, as an "additional high-need priority area." More information about the draft application is available here.

LeadingAge NY's comments express appreciation for the attention paid to long-term care in the application. They note, however, that the draft does not identify any funding for this high-priority sector. Since 40 percent of Medicaid spending under the State's Medicaid Global Cap is allocated to long-term care, LeadingAge NY is urging the State to allot 40 percent of the DSRIP funding to LTPAC initiatives. Its recommendations include $1.4 billion for long-term care workforce recruitment and retention investments, such as stipends for aide trainees and nursing students, loan forgiveness for nursing students, work-related supports (e.g., child care and transportation), and wage subsidies. In addition, LeadingAge NY recommends investment in innovative models of care, including expanding the use of nurse practitioners and physician assistants in nursing homes, comprehensive post-acute care management through home health care and adult day health care, transitional care programs from nursing homes to home, expansion of hospice utilization through advance care planning education and Electronic Medical Orders for Life-Sustaining Treatment (eMOLST) implementation, and person-centered dementia care models such as Comfort Matters. LeadingAge NY also requests investment in telehealth models and in electronic health record and health information exchange implementation and upgrades. To strengthen efforts to address the social determinants of health among older adults, it urges investment in resident assistants or service coordinators in affordable senior housing. Finally, LeadingAge NY recommends that the "value-driving entities" described in the application be required to include LTPAC providers and Managed Long Term Care (MLTC) plans in their leadership and operations. It also supports the creation of specialized LTPAC-led entities and asks that the startup costs of these entities be funded by the State. LeadingAge NY noted that provider-led, integrated duals plans provide a strong platform for value-based payment (VBP) arrangements.

LeadingAge NY will continue to update members on the progress of the DSRIP application as DOH makes revisions and submits its final application to the Centers for Medicare and Medicaid Services (CMS).

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383 ext. 124